Higgins, J Nicholas P, Borchert, Robin J, Rao, Sarita et al. · Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2024 · DOI
This study challenges how doctors define normal brain blood vessel patterns by examining 100 patients whose brain scans were reported as normal. Interestingly, nearly half had no final diagnosis, and many experienced symptoms like headaches, dizziness, and cognitive problems. The researchers suggest that some of these unexplained symptoms might actually be caused by subtle problems with how blood drains from the brain, rather than being 'all in the patient's head.'
For ME/CFS patients, many of whom experience unexplained headaches, dizziness, cognitive dysfunction, and fatigue despite normal conventional imaging, this study suggests that subtle cranial venous outflow problems may be a real physiological mechanism deserving clinical attention. It challenges the dismissal of these symptoms as purely functional or psychological, potentially opening pathways to investigate vascular contributions to ME/CFS and related post-viral syndromes.
This study does not prove that cranial venous insufficiency causes ME/CFS or other specific conditions in these patients. It is observational and cross-sectional, so it cannot establish causation or temporal relationships. The study also does not directly demonstrate that current MRI techniques can reliably detect subtle venous abnormalities, only that patients with 'normal' scans may have significant symptoms warranting further investigation.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Higgins, J Nicholas P, Borchert, Robin J, Rao, Sarita, Biddle, David J, Santarius, Thomas, & Joannides, Alexis J (2024). Cranial venous outflow insufficiency; rendered almost invisible to radiological imaging by circular reasoning. Rethinking normal craniocervical venous anatomy.. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. https://doi.org/10.1016/j.jocn.2024.110882
BibTeX
@article{mecfsatlas-higgins-2024-cranial-venous,
author = {Higgins, J Nicholas P and Borchert, Robin J and Rao, Sarita and Biddle, David J and Santarius, Thomas and Joannides, Alexis J},
title = {Cranial venous outflow insufficiency; rendered almost invisible to radiological imaging by circular reasoning. Rethinking normal craniocervical venous anatomy.},
journal = {Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia},
year = {2024},
doi = {10.1016/j.jocn.2024.110882},
note = {PubMed: 39509798},
url = {https://www.mecfsatlas.com/evidence/higgins-2024-cranial-venous},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/higgins-2024-cranial-venous
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